Improving viral load utilisation to enhance care for Kenyan adolescents with HIV

BMJ Open Quality

article

Gillian Dougherty¹  Steve Akoth²  Mark Hawken²  Isaac Leting²  Redempta Mutei²  Catherine Ngugi³  Doris Naitore²  Fatima Tsiouris¹  Anne Wakoli²  Lauren Walker¹  Miriam Rabkin¹ 

[1] ICAP at Columbia University , Mailman School of Public Health;ICAP Kenya;National AIDS and STI Control Program;Epidemiology , Columbia University Mailman School of Public Health

关键词: Quality improvement;    Continuous quality improvement;    Quality improvement methodologies;    Time-to-Treatment;    Collaborative;    breakthrough groups;   

DOI  :  10.1136/bmjoq-2022-001900

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Improving the use of viral load (VL) testing for adolescents and young people living with HIV (AYPLWH) is a priority for Kenya’s Ministry of Health (MOH). Despite expansion of VL testing coverage and rollout of national policies, guidelines and training, VL result utilisation for AYPLWH remains suboptimal, with inadequate adherence to national guidelines recommending everyone on antiretroviral therapy (ART) with unsuppressed viral load (UVL) (≥401 copies/mL) receive three enhanced adherence counselling (EAC) sessions and a repeat VL test within 3 months. In March 2019, ICAP at Columbia University partnered with the MOH to launch a Quality Improvement Collaborative (QIC) at 22 health facilities in the Eastern Province to optimise management of AYPLWH on ART with UVL. Over 17 months, facility QI teams tested interventions targeting client education, workflow modifications, commodity management, community engagement and improved documentation. The QIC led to marked improvement in the proportion of clients completing three EAC sessions and repeat VL testing. Median completion rate was 16% (n=479) at baseline (from March 2018 to February 2019) and rose to 73% (n=755) during the implementation period (from March 2019 to July 2020). In the final month (July 2020), rates rose to 90% (n=31). Another success was the increase in the proportion of clients whose VL was resuppressed on repeat testing, which improved from 34% (n=273) at baseline to 62% (n=710) during the implementation period and 77% (n=44) in the final month. The QIC also led to improvement in the proportion of AYPLWH on first-line ART whose regimens were switched within 2 months of recorded UVL results, which rose from 58% (n=48) at baseline to 94% (n=128) during the implementation period. In summary, the QIC helped facility teams to identify and prioritise local, contextually appropriate innovations which led to swift improvement in three critical indicators of VL utilisation.Quality improvementContinuous quality improvementQuality improvement methodologiesTime-to-TreatmentCollaborative, breakthrough groupsData availability statementData are available upon reasonable request.http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

【 授权许可】

CC BY-NC|CC BY|CC BY-NC-ND